A hydrocele is characterized by the accumulation of fluid within the serous membrane that covers the testicles. It causes symptoms such as swelling in the scrotum on one or both sides and a feeling of heaviness in the scrotum.
A hydrocele is common in babies, and usually resolves on its own within the first year of life. However, it can also appear in adults due to trauma, infections or tumors in the testicle.
It is important to consult a pediatrician or urologist if you notice symptoms of a hydrocele so that the most appropriate treatment can initiated if necessary.
Common symptoms
The main symptoms of a hydrocele are:
- Swelling in the scrotum
- A feeling of heaviness in the scrotum
- Discomfort or pain as swelling worsens
A hydrocele can affect one or both testicles, and the swelling may be noted to be mild in the morning and more noticeable at night. This can make it seem that the testicles are changing in size.
Confirming a diagnosis
A hydrocele is diagnosed by a urologist, who will first assess the patient's symptoms and health history. The doctor will then perform a physical examination by palpating the testicles and scrotum.
Generally, no additional tests are necessary to confirm a diagnosis, however, the doctor may request tests to rule out other health conditions that may present with similar symptoms, such as an inguinal hernia, testicular tumor, orchitis or epididymitis. In these cases, an ultrasound, abdominal x-ray and/or bloodwork may be ordered.
Possible causes
The main causes of a hydrocele are:
- A congenital defect that is present since birth
- Direct trauma or an injury to the scrotum;
- Infections, such as filariasis, tuberculosis of the epididymis, or syphilis
- A tumor or cancer in the testicle.
Inflammatory conditions, such as orchitis or epididymitis, can also increase the risk of a hydrocele.
Types of hydroceles
A hydrocele can be characterized into two types:
1. Communicating hydrocele
With this type of hydrocele, the patient has an open processus vaginalis, which connects the abdomen to the scotum. The processus vaginalis is a small pouch of tissue that forms when the fetus is development and closes once the testicles are in place.
An open processus vaginalis allows for fluid to flow freely between the abdomen and testicles, leading to fluid to accumulating in the scrotum.
This type of hydrocele is usually present from birth and commonly referred to as a primary hydrocele.
2. Non-communicating hydrocele
In non-communicating hydrocele, there is no connection between the abdomen and the scrotum, however fluid within the scrotal membrane is overproduced and/or there is an abnormality in how this fluid is absorbed.
This type of hydrocele can affect both babies and adults, and can appear congenitally or as a result of an injury or infection. These may also be referred to as a secondary hydrocele.
Treatment options
In most cases, hydroceles in babies do not require any type of treatment and resolve on their own within 1 year of age.
1. Watchful waiting
Watchful waiting may be recommended for adult men, who may be advised to monitor for symptoms and follow-up in 6 months to determine whether the fluid reabsorbs and resolves on its own.
2. Surgery
When the testicular hydrocele is causing a lot of discomfort or is progressively increasing over time, the doctor may advise a minor procedure with spinal anesthesia to totally or partially remove the membrane that covers the testicle.
This type of surgery is very simple and can be done in a few minutes. Recovery is generally quick, and it is possible to return home a few hours after surgery, once the effects of anesthesia have disappeared.
3. Aspiration
Aspiration of fluids from the scrotum with local anesthesia is another treatment option. however it is less commonly used as it is associated with agreater risk for complications and recurrence.